By filling this form, I understand and agree that the information contained in my application for pre-authorized debit must be communicated to the Payment Service Provider (Optimal Payments) and to my financial institution, to the extent that such disclosure is directly related to and necessary for the proper implementation of the rules on pre-authorized debits. I acknowledge that I have read and accepted all change and cancellation conditions, as well as all repayment terms, as stated in this authorization.